Phyllis quoted someone:

> I did my OB
> rotation in 1966, and  I don't remember concerns about weight loss,
jaundice, or
> hypoglycemia that  didn't result in symptoms.  If there were symptoms,
the baby
> was  treated.  If not, he wasn't.  And of course, we didn't have instant
adult
> glucometers then, so it meant a lab draw.>


A little history lesson here. I think that "1966" may be the operative term
in this observation. I think that may have been several years too early in
the development of perinatal medicine for many such insights.


In November 1968 when I took my last maternity leave, our hospital did not
have so much as a single bilirubin light in the premature nursery. Seldom
was the word "jaundice" even heard in relation to babies. Fluids, if
absolutely necessary, were given by hypodermoclysis. There were no IV's yet
being given to babies. By late 1969, the doctors were urging administration
to create a position for a person to do OB inservice education because of
all the new research being done at the dawn of perinatal medicine.  I was
offered the position and the chance to go, in early 1970, as part of a team
with a local pediatrician, to a 3 week course at the U. of Colorado where
much of the early research was going on about SGA, AGA and LGA babies,
placental physiology, LS ratios, the effects of cold stress, hypoglycemia,
jaundice, etc. etc. etc. (Thanks to the kindness and hospitality of a
Colorado LLLL and her family, my 15-month-old nursling received wonderful
daytime care while I was attending the sessions.)


Dr. J.D.Baum, famous British pediatrician and opthalmologist, was on the
faculty of the workshop.  It made a great impression on me when he said that
the cord and the placenta are the tools of prenatal nutrition, but cannot be
directly examined till after the baby no longer needs them, whereas the
breast and the nipple are visible for the entire 9 months before birth,
but are seldom examined for their potential to function efficiently as the
tools of postnatal nutrition. I suppose this made such an impression on me
because as a postpartum and nursery nurse and a childbirth educator, I had
already become interested in prenatal nipple function assessment, and the
prenatal preparation and photography of inverted nipples for case studies.


The hospital was soon to hire its first neonatologist. It was my job to come
back and do orientation of all new OB nursing personnel, and round-the-clock
inservices on all these subjects for the staff in all departments of OB.
This included my learning all about the very first labor monitors that were
just being purchased, and then inservicing all the L&D nurses on them and
the (primitive) meaning of the various fetal heart rate patterns, and
spending several weeks in surgery to learn to scrub for a scheduled CS, then
conducting drills for each shift to prepare L&D nurses to scrub for
emergency CS in L&D, etc.


I believe each of the other hospitals in town was pretty much at the same
stage and each found its own way to bring their staff up to speed on the new
developments in perinatology. We nurses from all hospitals "compared notes"
at NAACOG (later AWHONN) meetings. The rise in the use of ultrasound,
amniocentesis, etc. also occurred during that time, as it became apparent
that there are some risks in utero that make the baby's outcome better
if delivered prematurely and cared for in the NICU. All these insights were
brand new in the early 1970's, and rapidly began to change the protocols for
the care of infants, and soon after, the care of their mothers during
pregnancy as well as in labor.

Jean
*****************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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